Endothelial Function in Renal Transplant Recipients is Associated with Circulating Nitric Oxide, ACE Inhibitor Use and Time After Transplantation

With the use of modern immunosuppressive drugs short-time graft- and patient survival in renal transplant recipients is now in the range of 90% or better. In spite of this, these patients still die prematurely, primarily due to cardiovascular disease. The immunosuppressive treatment with both calcineurin inhibitors, such as cyclosporine A, and steroids contributes to the cardiovascular risk profile. Endothelial dysfunction has been shown to be a predictive factor for cardiovascular risk in non-transplanted patients. Several studies indicate that this is also true for renal transplant recipients, who have an established endothelial injury at the time of transplantation. In order to elucidate the mechanisms for endothelial damage we focused this analysis on the association between endothelial function and plasma levels of endothelin-1 (ET-1) and nitric oxide (NO), but other factors of potential importance for endothelial function were also included in the analysis. From the pooled analysis of 198 renal transplant recipients it was shown that plasma level of NO, but not ET-1, was an independent predictor of endothelial function in these patients. Further, it appears that endothelial dysfunction is partly reversed by ACE inhibitor treatment, whereas statin therapy was not shown to be an independent predictor in this analysis.